MEDICARE: MAGNOLIA HOME HEALTH AGENCY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	169423	CO

General Provider Information

NPI Number	:	1972555118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNOLIA HOME HEALTH AGENCY

Provider Business Mailing Address
First Line	:	6120 MOCCASIN PASS CT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-4433
Country	:	US
Telephone Number	:	719-302-4682
Fax Number	:

Provider Business Practice Location Address
First Line	:	6120 MOCCASIN PASS CT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-4433
Country	:	US
Telephone Number	:	719-302-4682
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. SCOTT EDWARD HARRISON
Credential	:
Telephone Number	:	719-302-4682

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	07/21/2022

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